Esophageal ultrasound (EUS) and endobronchial ultrasound (EBUS) have become major tools in the diagnosis of thoracic pathology. In the United States, there has been a “great divide” between the two; gastroenterologists alone enter the esophagus, and pulmonologists enter the airways. Whereas the EUS scope is large for airway insertion, the EBUS scope is easily inserted into the esophagus. We have found that there are situations in which esophageal access with the EBUS scope is logical and effective. Objective: To report recent experience using a linear EBUS scope through the esophagus in the diagnosis of thoracic lesions.
Retrospective review of patients who for whom an EBUS scope was used for trans-esophageal sampling of thoracic lesions.
Esophageal access was used for 8 patients. In two cases, the esophagus alone was used for access to thoracic lesions in the azygoesophageal recess. In one case, intractable cough led to an esophageal approach to mediastinal nodes. In two cases, cartilage in the upper airway made trans-tracheal access difficult, leading to an esophageal approach after a tracheal approach. In 3 more cases, both approaches to mediastinal nodes were used. In the 5 cases in which both trachea and esophagus were accessed, cytology for the two approaches was concordant in every case. No complications occurred.
Optimal patient care involves evaluation and diagnosis of each patient by one specialist and one procedure. The EBUS scope can be used effectively for sampling of thoracic structures from either channel; an arbitrary separation of how the central thorax is accessed seems artificial.
The linear EBUS scope can be safely and easily inserted into the esophagus to sample chest lesions. We have demonstrated this efficacy when there are issues with airway access or when the lesion is paraesophageal. This broadens the scope of the interventional pulmonologist in the diagnosis of lung cancer and other pulmonary diseases.
Wissam Abouzgheib, No Financial Disclosure Information; No Product/Research Disclosure Information